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Derbew AA, Debeb HG, Kinsman J, Myléus A, Byass P. Assessing the performance of the family folder system for collecting community-based health information in Tigray Region, North Ethiopia: a capture-recapture study. BMJ Open 2024; 14:e067735. [PMID: 38331856 PMCID: PMC10860088 DOI: 10.1136/bmjopen-2022-067735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 07/04/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES To assess completeness and accuracy of the family folder in terms of capturing community-level health data. STUDY DESIGN A capture-recapture method was applied in six randomly selected districts of Tigray Region, Ethiopia. PARTICIPANTS Child health data, abstracted from randomly selected 24 073 family folders from 99 health posts, were compared with similar data recaptured through household survey and routine health information made by these health posts. PRIMARY AND SECONDARY OUTCOME MEASURES Completeness and accuracy of the family folder data; and coverage selected child health indicators, respectively. RESULTS Demographic data captured by the family folders and household survey were highly concordant, concordance correlation for total population, women 15-49 years age and under 5-year child were 0.97 (95% CI 0.94 to 0.99, p<0.001), 0.73 (95% CI 0.67 to 0.88) and 0.91 (95% CI 0.85 to 0.96), respectively. However, the live births, child health service indicators and child health events were more erratically reported in the three data sources. The concordance correlation among the three sources, for live births and neonatal deaths was 0.094 (95% CI -0.232 to 0.420) and 0.092 (95% CI -0.230 to 0.423) respectively, and for the other parameters were close to 0. CONCLUSION The family folder system comprises a promising development. However, operational issues concerning the seamless capture and recording of events and merging community and facility data at the health centre level need improvement.
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Affiliation(s)
- Atakelti Abraha Derbew
- Ministry of Health, Addis Ababa, Ethiopia
- Department of health promotion and disease prevention, Tigray Health Bureau, Mekelle, Tigray, Ethiopia
| | | | - John Kinsman
- Department for Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anna Myléus
- Department for Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Family Medicine, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Peter Byass
- Department for Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Umeå Centre for Global Health Research, Umea Universitet, Umeå, Sweden
- MRC-Wits Rural Public Health and Health Transitions Research, University of the Witwatersrand Johannesburg Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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Choudhury N, Tiwari A, Wu WJ, Bhandari V, Bhatta L, Bogati B, Citrin D, Halliday S, Khadka S, Marasini N, Pandey S, Ballard M, Rayamazi HJ, Sapkota S, Schwarz R, Sullivan L, Maru D, Thapa A, Maru S. Comparing two data collection methods to track vital events in maternal and child health via community health workers in rural Nepal. Popul Health Metr 2022; 20:16. [PMID: 35897038 PMCID: PMC9327361 DOI: 10.1186/s12963-022-00293-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/03/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Timely tracking of health outcomes is difficult in low- and middle-income countries without comprehensive vital registration systems. Community health workers (CHWs) are increasingly collecting vital events data while delivering routine care in low-resource settings. It is necessary, however, to assess whether routine programmatic data collected by CHWs are sufficiently reliable for timely monitoring and evaluation of health interventions. To study this, we assessed the consistency of vital events data recorded by CHWs using two methodologies-routine data collected while delivering an integrated maternal and child health intervention, and data from a birth history census approach at the same site in rural Nepal. METHODS We linked individual records from routine programmatic data from June 2017 to May 2018 with those from census data, both collected by CHWs at the same site using a mobile platform. We categorized each vital event over a one-year period as 'recorded by both methods,' 'census alone,' or 'programmatic alone.' We further assessed whether vital events data recorded by both methods were classified consistently. RESULTS From June 2017 to May 2018, we identified a total of 713 unique births collectively from the census (birth history) and programmatic maternal 'post-delivery' data. Three-fourths of these births (n = 526) were identified by both. There was high consistency in birth location classification among the 526 births identified by both methods. Upon including additional programmatic 'child registry' data, we identified 746 total births, of which 572 births were identified by both census and programmatic methods. Programmatic data (maternal 'post-delivery' and 'child registry' combined) captured more births than census data (723 vs. 595). Both methods consistently classified most infants as 'living,' while infant deaths and stillbirths were largely classified inconsistently or recorded by only one method. Programmatic data identified five infant deaths and five stillbirths not recorded in census data. CONCLUSIONS Our findings suggest that data collected by CHWs from routinely tracking pregnancies, births, and deaths are promising for timely program monitoring and evaluation. Despite some limitations, programmatic data may be more sensitive in detecting vital events than cross-sectional census surveys asking women to recall these events.
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Affiliation(s)
- Nandini Choudhury
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA
| | | | - Wan-Ju Wu
- grid.429937.2Possible, New York, USA ,grid.239424.a0000 0001 2183 6745Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA USA
| | | | | | | | - David Citrin
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Anthropology, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Henry M. Jackson School of International Studies, University of Washington, Seattle, WA USA
| | - Scott Halliday
- grid.429937.2Possible, New York, USA ,grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
| | | | | | | | - Madeleine Ballard
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,Community Health Impact Coalition, New York, NY USA
| | | | | | - Ryan Schwarz
- grid.429937.2Possible, New York, USA ,grid.62560.370000 0004 0378 8294Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XDepartment of Medicine, Harvard Medical School, Boston, MA USA ,grid.32224.350000 0004 0386 9924Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Lisa Sullivan
- grid.189504.10000 0004 1936 7558Boston University School of Public Health, Boston, MA USA
| | - Duncan Maru
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA ,grid.59734.3c0000 0001 0670 2351Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | | | - Sheela Maru
- grid.429937.2Possible, New York, USA ,grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY USA ,grid.59734.3c0000 0001 0670 2351Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, New York, USA ,grid.59734.3c0000 0001 0670 2351Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY USA
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Bisrat H, Manyazewal T, Mohammed H, Shikur B, Yimer G. Validity of InterVA model versus physician review of verbal autopsy for tracking tuberculosis-related mortality in Ethiopia. BMC Infect Dis 2022; 22:200. [PMID: 35232392 PMCID: PMC8886901 DOI: 10.1186/s12879-022-07193-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In most African countries where a legitimate vital registration system is lacking, physicians often review verbal autopsy (VA) data to determine the cause of death, while there are concerns about the routine practicality, accuracy, and reliability of this procedure. In Ethiopia where the burden of tuberculosis (TB) remains unacceptably high, reliable VA data are needed to guide intervention strategies. This study aimed to validate the InterVA model against the physician VA in tracking TB-related mortality in Ethiopia. METHODS From a sample of deaths in Addis Ababa, Ethiopia, VAs were conducted on TB-related mortality, physician-certified verbal autopsy (PCVA) through multiple steps to ascertain the causes of death. InterVA model was used to interpret the causes of death. Estimates of TB-related deaths between physician reviews and the InterVA model were compared using Cohen's Kappa (k), Receiver-operator characteristic (ROC) curve analysis, sensitivity, and specificity to compare agreement between PCVA and InterVA. RESULTS A total of 8952 completed PCVA were used. The InterVA model had an optimal likelihood cut-off point sensitivity of 0.64 (95% CI: 59.0-69.0) and specificity of 0.95 (95% CI: 94.9-95.8). The area under the ROC curve was 0.79 (95% CI: 0.78-0.81). The level of agreement between physician reviews and the InterVA model to identifying TB-related mortality was moderate (k = 0.59, 95% CI: 0.57-0.61). CONCLUSION The InterVA model is a viable alternative to physician review for tracking TB-related causes of death in Ethiopia. From a public health perspective, InterVA helps to analyze the underlying causes of TB-related deaths cost-effectively using routine survey data and translate to policies and strategies in resource-constrained countries.
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Affiliation(s)
- Haileleuel Bisrat
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Hussen Mohammed
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Bilal Shikur
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getnet Yimer
- Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
- Department of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Regeru RN, Chikaphupha K, Bruce Kumar M, Otiso L, Taegtmeyer M. 'Do you trust those data?'-a mixed-methods study assessing the quality of data reported by community health workers in Kenya and Malawi. Health Policy Plan 2020; 35:334-345. [PMID: 31977014 PMCID: PMC7152729 DOI: 10.1093/heapol/czz163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/13/2022] Open
Abstract
High-quality data are essential to monitor and evaluate community health worker (CHW) programmes in low- and middle-income countries striving towards universal health coverage. This mixed-methods study was conducted in two purposively selected districts in Kenya (where volunteers collect data) and two in Malawi (where health surveillance assistants are a paid cadre). We calculated data verification ratios to quantify reporting consistency for selected health indicators over 3 months across 339 registers and 72 summary reports. These indicators are related to antenatal care, skilled delivery, immunization, growth monitoring and nutrition in Kenya; new cases, danger signs, drug stock-outs and under-five mortality in Malawi. We used qualitative methods to explore perceptions of data quality with 52 CHWs in Kenya, 83 CHWs in Malawi and 36 key informants. We analysed these data using a framework approach assisted by NVivo11. We found that only 15% of data were reported consistently between CHWs and their supervisors in both contexts. We found remarkable similarities in our qualitative data in Kenya and Malawi. Barriers to data quality mirrored those previously reported elsewhere including unavailability of data collection and reporting tools; inadequate training and supervision; lack of quality control mechanisms; and inadequate register completion. In addition, we found that CHWs experienced tensions at the interface between the formal health system and the communities they served, mediated by the social and cultural expectations of their role. These issues affected data quality in both contexts with reports of difficulties in negotiating gender norms leading to skipping sensitive questions when completing registers; fabrication of data; lack of trust in the data; and limited use of data for decision-making. While routine systems need strengthening, these more nuanced issues also need addressing. This is backed up by our finding of the high value placed on supportive supervision as an enabler of data quality.
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Affiliation(s)
| | | | - Meghan Bruce Kumar
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
| | - Lilian Otiso
- Research Division, LVCT Health, PO Box 19835-00202, Nairobi, Kenya
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
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Kumar MB, Taegtmeyer M, Madan J, Ndima S, Chikaphupha K, Kea A, Barasa E. How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries. Health Policy Plan 2020; 35:799-809. [PMID: 32516361 PMCID: PMC7487332 DOI: 10.1093/heapol/czaa027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 11/29/2022] Open
Abstract
Various investments could help countries deliver on the universal health coverage (UHC) goals set by the global community; community health is a pillar of many national strategies towards UHC. Yet despite resource mobilization towards this end, little is known about the potential costs and value of these investments, as well as how evidence on the same would be used in related decisions. This qualitative study was conducted to understand the use of evidence in policy and financing decisions for large-scale community health programmes in low- and middle-income countries. Through key informant interviews with 43 respondents in countries with community health embedded in national UHC strategies (Ethiopia, Kenya, Malawi, Mozambique) and at global institutions, we investigated evidence use in community health financing and policy decision-making, as well as evidentiary needs related to community health data for decision-making. We found that evidence use is limited at all levels, in part due to a perceived lack of high-quality, relevant evidence. This perception stems from two main areas: first, desire for local evidence that reflects the context, and second, much existing economic evidence does not deal with what decision-makers value when it comes to community health systems-i.e. coverage and (to a lesser extent) quality. Beyond the evidence gap, there is limited capacity to assess and use the evidence. Elected officials also face political challenges to disinvestment as well as structural obstacles to evidence use, including the outsized influence of donor priorities. Evaluation data must to speak to decision-maker interests and constraints more directly, alongside financiers of community health providing explicit guidance and support on the role of evidence use in decision-making, empowering national decision-makers. Improved data quality, increased relevance of evidence and capacity for evidence use can drive improved efficiency of financing and evidence-based policymaking.
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Affiliation(s)
- Meghan Bruce Kumar
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam Taegtmeyer
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sozinho Ndima
- Community Health Department, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | | | - Aschenaki Kea
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
- Center for International Health, University of Bergen, Bergen, Norway
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Aguiar M, Farley A, Hope L, Amin A, Shah P, Manaseki-Holland S. Birth-Related Perineal Trauma in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. Matern Child Health J 2019; 23:1048-1070. [PMID: 30915627 PMCID: PMC6606670 DOI: 10.1007/s10995-019-02732-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Birth-related perineal trauma (BPT) is a common consequence of vaginal births. When poorly managed, BPT can result in increased morbidity and mortality due to infections, haemorrhage, and incontinence. This review aims to collect data on rates of BPT in low- and middle-income countries (LMICs), through a systematic review and meta-analysis. Methods The following databases were searched: Medline, Embase, Latin American and Caribbean Health Sciences Literature (LILACs), and the World Health Organization (WHO) regional databases, from 2004 to 2016. Cross-sectional data on the proportion of vaginal births that resulted in episiotomy, second degree tears or obstetric anal sphincter injuries (OASI) were extracted from studies carried out in LMICs by two independent reviewers. Estimates were meta-analysed using a random effects model; results were presented by type of BPT, parity, and mode of birth. Results Of the 1182 citations reviewed, 74 studies providing data on 334,054 births in 41 countries were included. Five studies reported outcomes of births in the community. In LMICs, the overall rates of BPT were 46% (95% CI 36–55%), 24% (95% CI 17–32%), and 1.4% (95% CI 1.2–1.7%) for episiotomies, second degree tears, and OASI, respectively. Studies were highly heterogeneous with respect to study design and population. The overall reporting quality was inadequate. Discussion Compared to high-income settings, episiotomy rates are high in LMIC medical facilities. There is an urgent need to improve reporting of BPT in LMICs particularly with regards to births taking in community settings.
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Affiliation(s)
- Magda Aguiar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lucy Hope
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Nursing and Midwifery, Institute of Health & Society, University of Worcester, Worcester, UK
| | - Adeela Amin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pooja Shah
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Suthar AB, Khalifa A, Yin S, Wenz K, Ma Fat D, Mills SL, Nichols E, AbouZahr C, Mrkic S. Evaluation of approaches to strengthen civil registration and vital statistics systems: A systematic review and synthesis of policies in 25 countries. PLoS Med 2019; 16:e1002929. [PMID: 31560684 PMCID: PMC6764661 DOI: 10.1371/journal.pmed.1002929] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Civil registration and vital statistics (CRVS) systems play a key role in upholding human rights and generating data for health and good governance. They also can help monitor progress in achieving the United Nations Sustainable Development Goals. Although many countries have made substantial progress in strengthening their CRVS systems, most low- and middle-income countries still have underdeveloped systems. The objective of this systematic review is to identify national policies that can help countries strengthen their systems. METHODS AND FINDINGS The ABI/INFORM, Embase, JSTOR, PubMed, and WHO Index Medicus databases were systematically searched for policies to improve birth and/or death registration on 24 January 2017. Global stakeholders were also contacted for relevant grey literature. For the purposes of this review, policies were categorised as supply, demand, incentive, penalty, or combination (i.e., at least two of the preceding policy approaches). Quantitative results on changes in vital event registration rates were presented for individual comparative articles. Qualitative systematic review methodology, including meta-ethnography, was used for qualitative syntheses on operational considerations encompassing acceptability to recipients and staff, human resource requirements, information technology or infrastructure requirements, costs to the health system, unintended effects, facilitators, and barriers. This study is registered with PROSPERO, number CRD42018085768. Thirty-five articles documenting experience in implementing policies to improve birth and/or death registration were identified. Although 25 countries representing all global regions (Africa, the Americas, Southeast Asia, the Western Pacific, Europe, and the Eastern Mediterranean) were reflected, there were limited countries from the Eastern Mediterranean and Europe regions. Twenty-four articles reported policy effects on birth and/or death registration. Twenty-one of the 24 articles found that the change in registration rate after the policy was positive, with two supply and one penalty articles being the exceptions. The qualitative syntheses identified 15 operational considerations across all policy categories. Human and financial resource requirements were not quantified. The primary limitation of this systematic review was the threat of publication bias wherein many countries may not have documented their experience; this threat is most concerning for policies that had neutral or negative effects. CONCLUSIONS Our systematic review suggests that combination policy approaches, consisting of at least a supply and demand component, were consistently associated with improved registration rates in different geographical contexts. Operational considerations should be interpreted based on health system, governance, and sociocultural context. More evaluations and research are needed from the Eastern Mediterranean and Europe regions. Further research and evaluation are also needed to estimate the human and financial resource requirements required for different policies.
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Affiliation(s)
- Amitabh Bipin Suthar
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Aleya Khalifa
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Sherry Yin
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristen Wenz
- Programme Division, United Nations Children’s Fund, New York City, New York, United States of America
| | - Doris Ma Fat
- Health Statistics and Informatics Department, World Health Organization, Geneva, Switzerland
| | - Samuel Lantei Mills
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington DC, United States of America
| | - Erin Nichols
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, United States of America
| | - Carla AbouZahr
- Bloomberg Data for Health Initiative, New York City, New York, United States of America
| | - Srdjan Mrkic
- Statistics Division, United Nations, New York City, New York, United States of America
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Nichols EK, Ragunanthan NW, Ragunanthan B, Gebrehiwet H, Kamara K. A systematic review of vital events tracking by community health agents. Glob Health Action 2019; 12:1597452. [PMID: 31179875 PMCID: PMC6566585 DOI: 10.1080/16549716.2019.1597452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Efforts to improve national civil registration and vital statistics (CRVS) systems are focusing on transforming traditionally passive systems into active systems that have the ability to reach the household level. While community health agents remain at the core of many birth and death reporting efforts, previous literature has not explored elements for their successful integration into CRVS efforts. Objective: To inform future efforts to improve CRVS systems, we conducted a systematic review of literature to understand and describe the design features, resulting data quality, and factors impacting the performance of community health agents involved in tracking vital events. Methods: We reviewed 393 articles; reviewers extracted key information from 58 articles meeting the eligibility criteria: collection of birth and/or death information outside of a clinic environment by a community agent. Reviewers recorded information in an Excel database on various program aspects, and results were summarized into key themes and topic areas. Results: The majority of articles described work in rural areas of Africa or South-East Asia. Nearly all articles (86%) cited some form of household visitation by community health agents. Only one article described a process in which vital events tracking activities were linked to official vital events registers. Other factors commonly described included program costs, relationship of community agents to community, and use of mobile devices. About 1/3 of articles reported quantitative information on performance and quality of vital events data tracked; various methods were described for measuring completeness of reporting, which varied greatly across articles. Conclusions: The multitude of articles on this topic attests to the availability of community health agents to track vital events. Creating a programmatic norm of integrating with CRVS systems the vital events information collected from existing community health programs has the potential to provide governments with information essential for public health decision-making.
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Affiliation(s)
- Erin K Nichols
- a National Center for Health Statistics , Centers for Disease Control and Prevention , Hyattsville , MD , USA.,b Department of Health and Human Services , United States Public Health Service , Washington, DC , USA
| | - Nina W Ragunanthan
- c Department of Obstetrics, Gynecology, and Reproductive Sciences , University of Pittsburgh Medical Center Magee-Womens Hospital , Pittsburgh , PA , USA
| | - Braveen Ragunanthan
- d Department of Pediatrics , University of Pittsburgh Medical Center Children's Hospital of Pittsburgh , Pittsburgh , PA , USA
| | - Hermon Gebrehiwet
- e Health Sciences Program , Argosy University , Arlington , VA , USA
| | - Karim Kamara
- f School of Health Professions , Shenandoah University , Winchester , VA , USA
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O'Connor EC, Hutain J, Christensen M, Kamara MS, Conteh A, Sarriot E, Samba TT, Perry HB. Piloting a participatory, community-based health information system for strengthening community-based health services: findings of a cluster-randomized controlled trial in the slums of Freetown, Sierra Leone. J Glob Health 2019; 9:010418. [PMID: 30842881 PMCID: PMC6394878 DOI: 10.7189/jogh.09.010418] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although community engagement has been promoted as a strategy for health systems strengthening, there is need for more evidence for effectiveness of this approach. We describe an operations research (OR) Study and assessment of one form of community engagement, the development and implementation of a participatory community-based health information system (PCBHIS), in slum communities in Freetown, Sierra Leone. METHODS A child survival project was implemented in 10 slum communities, which were then randomly allocated to intervention (PCBHIS) and comparison areas. In the 5 PCBHIS communities, the findings from monthly reports submitted by community health workers (CHWs) and verbal autopsy findings for deaths of children who died before reaching 5 years of age, were processed and shared at bimonthly meetings in each community. These meetings, called Community Health Data Review (CHDR) meetings, were attended by community leaders, including members of the Ward Development Committee (WDC) and Health Management Committee (HMC), by the CHW Peer Supervisors, and by representatives of the Peripheral Health Unit. Following a review of the information, attendees proposed actions to strengthen community-based health services in their community. These meetings were held over a period of 20 months from July 2015 to March 2017. At baseline and endline, knowledge, practice and coverage (KPC) surveys measured household health-related behaviors and care-seeking behaviors. The capacity of HMCs and WDCs to engage with the local health system was also measured at baseline and endline. Reports of CHW household contact and assessments of CHW quality were obtained in the endline KPC household survey, and household contacts measured in monthly submitted reports were also tabulated. RESULTS The self-assessment scores of WDCs' capacity to fulfil their roles improved more in the intervention than in the comparison area for all six components, but for only 1 of the 6 was the improvement statistically significant (monthly and quarterly meetings in which Peer Supervisor and/or CHW supervision was an agenda item). The scores for the HMCs improved less in the intervention area than in the comparison area for all six components, but none of these differences were statistically significant. Topics of discussion in CHDRs focused primarily on CHW functionality. All three indicators of CHW functioning (as measured by reports submitted from CHWs) improved more in the intervention area relative to the comparison area, with 2 out of 3 measures of improvement reaching statistical significance. Five of 7 household behaviors judged to be amenable to promotion by CHWs improved more in the intervention area than in the comparison area, and 2 out of the 5 were statistically significant (feeding colostrum and appropriate infant and young child feeding). Four of the 6 care-seeking behaviors judged to be amenable to promotion by CHWs improved more in the intervention area than in the comparison area, and 1 was statistically significant (treatment of diarrhea with ORS and zinc). None of the findings that favored the comparison area were statistically significant. CONCLUSIONS This study was implemented in challenging circumstances. The OR Study intervention was delayed because of interruptions in finalizing the national CHW policy, two separate cholera epidemics, and the Ebola epidemic lasting more than 2 years. Weaknesses in the CHW intervention severely limited the extent to which the PCBHIS could be used to observe trends in mortality and morbidity. Nonetheless, the positive results achieved in the area of functionality of the CHW intervention and community structure capacity are encouraging. Results suggest there is value in further methodologically rigorous investigations into improving community-based health system functioning through a similar approach to community engagement.
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Affiliation(s)
| | | | | | | | - Abu Conteh
- Formerly Concern Worldwide/Sierra Leone, Freetown, Sierra Leone
| | | | - Thomas T Samba
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Henry B Perry
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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10
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Guerra J, Acharya P, Barnadas C. Community-based surveillance: A scoping review. PLoS One 2019; 14:e0215278. [PMID: 30978224 PMCID: PMC6461245 DOI: 10.1371/journal.pone.0215278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/31/2019] [Indexed: 12/22/2022] Open
Abstract
Background Involving community members in identifying and reporting health events for public health surveillance purposes, an approach commonly described as community-based surveillance (CBS), is increasingly gaining interest. We conducted a scoping review to list terms and definitions used to characterize CBS, to identify and summarize available guidance and recommendations, and to map information on past and existing in-country CBS systems. Methods We searched eight bibliographic databases and screened the worldwide web for any document mentioning an approach in which community members both collected and reported information on health events from their community for public health surveillance. Two independent reviewers performed double blind screening and data collection, any discrepancy was solved through discussion and consensus. Findings From the 134 included documents, several terms and definitions for CBS were retrieved. Guidance and recommendations for CBS were scattered through seven major guides and sixteen additional documents. Seventy-nine unique CBS systems implemented since 1958 in 42 countries were identified, mostly implemented in low and lower-middle income countries (79%). The systems appeared as fragmented (81% covering a limited geographical area and 70% solely implemented in a rural setting), vertical (67% with a single scope of interest), and of limited duration (median of 6 years for ongoing systems and 2 years for ended systems). Collection of information was mostly performed by recruited community members (80%). Interpretation While CBS has already been implemented in many countries, standardization is still required on the term and processes to be used. Further research is needed to ensure CBS integrates effectively into the overall public health surveillance system.
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Affiliation(s)
- José Guerra
- World Health Organization (WHO), Lyon, France
- * E-mail:
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11
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Sloan NL, Storey A, Fasawe O, Yakubu J, McCrystal K, Wiwa O, Lothe LJ, Grepstad M. Advancing Survival in Nigeria: A Pre-post Evaluation of an Integrated Maternal and Neonatal Health Program. Matern Child Health J 2019; 22:986-997. [PMID: 29427018 PMCID: PMC5976701 DOI: 10.1007/s10995-018-2476-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Nigeria contributes more obstetric, postpartum and neonatal deaths and stillbirths globally than any other country. The Clinton Health Access Initiative in partnership with the Nigerian Federal Ministry of Health and the state Governments of Kano, Katsina, and Kaduna implemented an integrated Maternal and Neonatal Health program from July 2014. Up to 90% women deliver at home in Northern Nigeria, where maternal mortality ratio and neonatal mortality rates (MMR and NMR) are high and severe challenges to improving survival exist. Methods Community-based leaders (“key informants”) reported monthly vital events. Pre-post comparisons of later (months 16–18) with conservative baseline (months 7–9) rates were used to assess change in MMR, NMR, perinatal mortality (PMR) and stillbirth. Two-tailed cross-tabulations and unadjusted and adjusted logistic regression analyses were conducted. Results Data on 147,455 births (144,641 livebirths and 4275 stillbirths) were analyzed. At endline (months 16–18), MMR declined 37% (OR 0.629, 95% CI 0.490–0.806, p ≤ 0.0003) vs. baseline 440/100,000 births (months 7–9). NMR declined 43% (OR 0.574, 95% CI 0.503–0.655, p < 0.0001 vs. baseline 15.2/1000 livebirths. Stillbirth rates declined 15% (OR 0.850, 95% CI 0.768–0.941, p = 0.0018) vs. baseline 21.1/1000 births. PMR declined 27% (OR 0.733, 95% CI 0.676–0.795, p < 0.0001) vs. baseline 36.0/1000 births. Adjusted results were similar. Discussion The findings are similar to the Cochrane Review effects of community-based interventions and indicate large survival improvements compared to much slower global and flat national trends. Key informant data have limitations, however, their limitations would have little effect on the results magnitude or significance.
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Affiliation(s)
| | - Andrew Storey
- Clinton Health Access Initiative, 383 Dorcester Avenue, Suite 400, Boston, MA, 02127, USA
| | - Olufunke Fasawe
- Clinton Health Access Initiative, 7B Ganges St. Maitama, Abuja, Nigeria
| | - Jamila Yakubu
- Clinton Health Access Initiative, 7B Ganges St. Maitama, Abuja, Nigeria
| | - Kelly McCrystal
- Clinton Health Access Initiative, 383 Dorcester Avenue, Suite 400, Boston, MA, 02127, USA
| | - Owens Wiwa
- Clinton Health Access Initiative, 7B Ganges St. Maitama, Abuja, Nigeria
| | - Lene Jeanette Lothe
- Norwegian Agency for Development Cooperation, Bygdøy Allé 2, 0257, Oslo, Norway
| | - Mari Grepstad
- Norwegian Agency for Development Cooperation, Bygdøy Allé 2, 0257, Oslo, Norway
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12
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Corrêa G, Verstraete P, Soundardjee R, Shankar M, Paterson C, Hampton L, Jackson D, Muniz M, Mwamba R, Wenz K, Bratschi MW, AbouZahr C, Johnson H. Immunization programmes and notifications of vital events. Bull World Health Organ 2019; 97:306-308. [PMID: 30940988 PMCID: PMC6438247 DOI: 10.2471/blt.18.210807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 12/10/2018] [Accepted: 12/25/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gustavo Corrêa
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex Geneva, Switzerland
| | - Philippe Verstraete
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex Geneva, Switzerland
| | - Riswana Soundardjee
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex Geneva, Switzerland
| | - Manjari Shankar
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex Geneva, Switzerland
| | - Colin Paterson
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex Geneva, Switzerland
| | - Lee Hampton
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex Geneva, Switzerland
| | - Debra Jackson
- Health section, United Nations Children's Fund, New York, United States of America (USA)
| | - Maria Muniz
- Health section, United Nations Children's Fund, New York, United States of America (USA)
| | - Remy Mwamba
- Health section, United Nations Children's Fund, New York, United States of America (USA)
| | - Kristen Wenz
- Child Protection section, United Nations Children's Fund, New York, USA
| | | | - Carla AbouZahr
- Bloomberg Data for Health Initiative, University of Melbourne, Melbourne, Australia
| | - Hope Johnson
- Gavi, the Vaccine Alliance, Global Health Campus, Chemin du Pommier 40, 1218 Grand-Saconnex Geneva, Switzerland
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13
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Mobile applications: effective tools against HIV in Africa. HEALTH AND TECHNOLOGY 2018. [DOI: 10.1007/s12553-017-0200-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Using community-based reporting of vital events to monitor child mortality: Lessons from rural Ghana. PLoS One 2018; 13:e0192034. [PMID: 29381745 PMCID: PMC5790256 DOI: 10.1371/journal.pone.0192034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 01/16/2018] [Indexed: 12/02/2022] Open
Abstract
Background Reducing neonatal and child mortality is a key component of the health-related sustainable development goal (SDG), but most low and middle income countries lack data to monitor child mortality on an annual basis. We tested a mortality monitoring system based on the continuous recording of pregnancies, births and deaths by trained community-based volunteers (CBV). Methods and findings This project was implemented in 96 clusters located in three districts of the Northern Region of Ghana. Community-based volunteers (CBVs) were selected from these clusters and were trained in recording all pregnancies, births, and deaths among children under 5 in their catchment areas. Data collection lasted from January 2012 through September 2013. All CBVs transmitted tallies of recorded births and deaths to the Ghana Birth and deaths registry each month, except in one of the study districts (approximately 80% reporting). Some events were reported only several months after they had occurred. We assessed the completeness and accuracy of CBV data by comparing them to retrospective full pregnancy histories (FPH) collected during a census of the same clusters conducted in October-December 2013. We conducted all analyses separately by district, as well as for the combined sample of all districts. During the 21-month implementation period, the CBVs reported a total of 2,819 births and 137 under-five deaths. Among the latter, there were 84 infant deaths (55 neonatal deaths and 29 post-neonatal deaths). Comparison of the CBV data with FPH data suggested that CBVs significantly under-estimated child mortality: the estimated under-5 mortality rate according to CBV data was only 2/3 of the rate estimated from FPH data (95% Confidence Interval for the ratio of the two rates = 51.7 to 81.4). The discrepancies between the CBV and FPH estimates of infant and neonatal mortality were more limited, but varied significantly across districts. Conclusions In northern Ghana, a community-based data collection systems relying on volunteers did not yield accurate estimates of child mortality rates. Additional implementation research is needed to improve the timeliness, completeness and accuracy of such systems. Enhancing pregnancy monitoring, in particular, may be an essential step to improve the measurement of neonatal mortality.
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15
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Nomura M, Xangsayarath P, Takahashi K, Kamiya Y, Siengsounthone L, Ogino H, Kobayashi J. Socioeconomic determinants of accessibility to birth registration in Lao PDR. BMC Public Health 2018; 18:116. [PMID: 29310660 PMCID: PMC5759213 DOI: 10.1186/s12889-017-5009-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 12/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The global coverage rate of birth registration is only around 65% for the population of children under five although birth registration secures protection and access to health services that are fundamental rights for all babies. This study aimed to perform a basic analysis of the accessibility to birth registration to better understand how to improve the birth registration system in the Lao PDR. METHODS For the analysis of birth registration and related socioeconomic factors, 9576 mother-child pairs were chosen from the data set of The Lao Social Indicator Survey 2011-12. After bivariate analysis with statistical tests including the chi-square test were conducted, logistic regression was performed to determine the variables that statistically influence accessibility to birth registration. RESULTS Ethno-geographic factors and place of delivery were observed to be the factors associated with birth registration in this analysis. CONCLUSION Many mothers in the Lao PDR deliver in their local communities. Therefore, capacity development of various human resources, such as Skilled Birth Attendant, to support the local administrative procedure of birth registration in their communities could be one option to overcoming the bottlenecks in the birth registration process in the Lao PDR.
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Affiliation(s)
- Marika Nomura
- Department of International Health and Collaboration, National Institute of Public Health, 2-3-6 Minami, Wako-shi, Saitama, 351-0197, Japan.
| | | | | | | | | | - Hina Ogino
- Yokkaichi Nursing and Medical Care University, Mie, Japan
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16
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Olaniran A, Smith H, Unkels R, Bar-Zeev S, van den Broek N. Who is a community health worker? - a systematic review of definitions. Glob Health Action 2017; 10:1272223. [PMID: 28222653 PMCID: PMC5328349 DOI: 10.1080/16549716.2017.1272223] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/22/2016] [Accepted: 12/08/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. OBJECTIVE To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. DESIGN A systematic review of peer-reviewed papers and grey literature. RESULTS We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. CONCLUSIONS This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research.
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Affiliation(s)
- Abimbola Olaniran
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Smith
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Regine Unkels
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sarah Bar-Zeev
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nynke van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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17
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Harsha Bangura A, Ozonoff A, Citrin D, Thapa P, Nirola I, Maru S, Schwarz R, Raut A, Belbase B, Halliday S, Adhikari M, Maru D. Practical issues in the measurement of child survival in health systems trials: experience developing a digital community-based mortality surveillance programme in rural Nepal. BMJ Glob Health 2016; 1:e000050. [PMID: 28588974 PMCID: PMC5321370 DOI: 10.1136/bmjgh-2016-000050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 10/24/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022] Open
Abstract
Child mortality measurement is essential to the impact evaluation of maternal and child healthcare systems interventions. In the absence of vital statistics systems, however, assessment methodologies for locally relevant interventions are severely challenged. Methods for assessing the under-5 mortality rate for cross-country comparisons, often used in determining progress towards development targets, pose challenges to implementers and researchers trying to assess the population impact of targeted interventions at more local levels. Here, we discuss the programmatic approach we have taken to mortality measurement in the context of delivering healthcare via a public–private partnership in rural Nepal. Both government officials and the delivery organisation, Possible, felt it was important to understand child mortality at a fine-grain spatial and temporal level. We discuss both the short-term and the long-term approach. In the short term, the team chose to use the under-2 mortality rate as a metric for mortality measurement for the following reasons: (1) as overall childhood mortality declines, like it has in rural Nepal, deaths concentrate among children under the age of 2; (2) 2-year cohorts are shorter and thus may show an impact more readily in the short term of intervention trials; and (3) 2-year cohorts are smaller, making prospective census cohorts more feasible in small populations. In the long term, Possible developed a digital continuous surveillance system to capture deaths as they occur, at which point under-5 mortality assessment would be desirable, largely owing to its role as a global standard.
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Affiliation(s)
- Alex Harsha Bangura
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Al Ozonoff
- Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, Center for Patient Safety and Quality Research, Boston, MA, USA
| | - David Citrin
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,University of Washington, Department of Anthropology, Seattle, WA, USA.,University of Washington, Department of Global Health, Seattle, WA, USA.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - Poshan Thapa
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Isha Nirola
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Sheela Maru
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Boston Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA.,Boston University School of Medicine, Department of Obstetrics and Gynecology, Boston, MA, USA.,Brigham and Women's Hospital, Department Medicine, Division of Women's Health, Boston, MA, USA
| | - Ryan Schwarz
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Massachusetts General Hospital, Department of Medicine, Division of General Internal Medicine, Boston, MA, USA
| | - Anant Raut
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Bishal Belbase
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal
| | - Scott Halliday
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,University of Washington, Henry M. Jackson School of International Studies, Seattle, WA, USA
| | - Mukesh Adhikari
- Ministry of Health, Department of Health Services, District Health Office, Mangalsen, Achham, Nepal
| | - Duncan Maru
- Possible, Bayalpata Hospital, Sanfebagar-10, Achham, Nepal.,Brigham and Women's Hospital, Department of Medicine, Division of Global Health Equity, Boston, MA, USA.,Harvard Medical School, Department of Medicine, Boston, MA, USA.,Boston Children's Hospital, Department of Medicine, Division of General Pediatrics, Boston, MA, USA
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18
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Mushi AK, Massaga JJ, Mandara CI, Mubyazi GM, Francis F, Kamugisha M, Urassa J, Lemnge M, Mgohamwende F, Mkude S, Schellenberg JA. Acceptability of malaria rapid diagnostic tests administered by village health workers in Pangani District, North eastern Tanzania. Malar J 2016; 15:439. [PMID: 27567531 PMCID: PMC5002154 DOI: 10.1186/s12936-016-1495-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 08/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Malaria continues to top the list of the ten most threatening diseases to child survival in Tanzania. The country has a functional policy for appropriate case management of malaria with rapid diagnostic tests (RDTs) from hospital level all the way to dispensaries, which are the first points of healthcare services in the national referral system. However, access to these health services in Tanzania is limited, especially in rural areas. Formalization of trained village health workers (VHWs) can strengthen and extend the scope of public health services, including diagnosis and management of uncomplicated malaria in resource-constrained settings. Despite long experience with VHWs in various health interventions, Tanzania has not yet formalized its involvement in malaria case management. This study presents evidence on acceptability of RDTs used by VHWs in rural northeastern Tanzania. Methods A cross-sectional study using quantitative and qualitative approaches was conducted between March and May 2012 in Pangani district, northeastern Tanzania, on community perceptions, practices and acceptance of RDTs used by VHWs. Results Among 346 caregivers of children under 5 years old, no evidence was found of differences in awareness of HIV rapid diagnostic tests and RDTs (54 vs. 46 %, p = 0.134). Of all respondents, 92 % expressed trust in RDT results, 96 % reported readiness to accept RDTs by VHWs, while 92 % expressed willingness to contribute towards the cost of RDTs used by VHWs. Qualitative results matched positive perceptions, attitudes and acceptance of mothers towards the use of RDTs by VHWs reported in the household surveys. Appropriate training, reliable supplies, affordability and close supervision emerged as important recommendations for implementation of RDTs by VHWs. Conclusion RDTs implemented by VHWs are acceptable to rural communities in northeastern Tanzania. While families are willing to contribute towards costs of sustaining these services, policy decisions for scaling-up will need to consider the available and innovative lessons for successful universally accessible and acceptable services in keeping with national health policy and sustainable development goals.
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Affiliation(s)
- Adiel K Mushi
- Centre for Enhancement of Effective Malaria Interventions, 2448, Barack Obama Drive, P.O. Box 9653, Dar es Salaam, Tanzania. .,National Institute for Medical Research, HQ, 3 Barack Obama Drive, 11101, Dar es Salaam, Tanzania.
| | - Julius J Massaga
- Centre for Enhancement of Effective Malaria Interventions, 2448, Barack Obama Drive, P.O. Box 9653, Dar es Salaam, Tanzania.,National Institute for Medical Research, HQ, 3 Barack Obama Drive, 11101, Dar es Salaam, Tanzania
| | - Celine I Mandara
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania
| | - Godfrey M Mubyazi
- Centre for Enhancement of Effective Malaria Interventions, 2448, Barack Obama Drive, P.O. Box 9653, Dar es Salaam, Tanzania.,National Institute for Medical Research, HQ, 3 Barack Obama Drive, 11101, Dar es Salaam, Tanzania
| | - Filbert Francis
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania
| | - Mathias Kamugisha
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania
| | - Jenesta Urassa
- National Institute for Medical Research, HQ, 3 Barack Obama Drive, 11101, Dar es Salaam, Tanzania
| | - Martha Lemnge
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania
| | - Fidelis Mgohamwende
- National malaria Control Programme, Ministry of Health and Social Welfare, 6 Samora Machel Avenue, 11478, Dar es Salaam, Tanzania
| | - Sigbert Mkude
- National malaria Control Programme, Ministry of Health and Social Welfare, 6 Samora Machel Avenue, 11478, Dar es Salaam, Tanzania
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Abstract
Bryce and colleagues, reflect on lessons that can be learned from the Real-Time Monitoring of Under-Five Mortality Collection.
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20
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Abstract
Jennifer Bryce and the RMM Working Group describe the origin and rationale of the Real-Time Monitoring of Under-Five Mortality Collection.
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Affiliation(s)
- Jennifer Bryce
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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